Increased Risk of Suicide Attempts and Unintended Death Among Those Transitioning From Prison to Community in Later Life

Objective: The number of individuals transitioning from correctional facilities to community in later life (age >= 50 ) is increasing. We sought to determine if later-life prison release is a risk factor for suicidal behavior and death by accidental injury, including drug overdose. Design: Retrospective cohort study. Setting: U.S. Department of Veterans Affairs and Medicare healthcare systems, 2012-2014. Participants: Veterans age >= 50 released from correctional facilities (N = 7,671 re-entry veterans) and those never incarcerated (N = 7,671). Methods: Dates of suicide attempt and cause-specific mortality defined using the National Suicide Prevention Applications Network and the National Suicide Data Repository, respectively. Results: Later-life prison release was associated with increased risk of suicide attempt (599.7 versus 134.7 per 100,000 per year; adjusted hazard ratio [HR] 3.45; 95% confidence interval [CI] 2.24-5.32; p < 0.001, Wald chi(2) = 31.58, degrees of freedom [df] = 1), death by drug overdose (121.7 versus 43.5; adjusted HR 3.45; 95% CI 1.37-8.73; p = 0.009, Wald chi(2) = 6.86, df = 1), and other accidental injury (126.0 versus 39.1; adjusted HR 3.13; 95% CI 1.28-7.69; p = 0.013, Wald chi(2) = 6.25, df = 1), adjusting for homelessness, traumatic brain injury, medical and psychiatric conditions, and accounting for competing risk of other deaths. Suicide mortality rates were observed as nonsignificant between re-entry veterans and those never incarcerated (30.4 versus 17.4, respectively; adjusted HR 2.40; 95% CI 0.51-11.24; p = 0.266, Wald chi(2) = 1.23, df = 1). Conclusion: Older re-entry veterans are at considerable risk of attempting suicide and dying by drug overdose or other accidental injury. This study highlights importance of prevention and intervention efforts targeting later-life prison-to-community care transitions.